Comparison of Functional Outcome between Early Versus Delayed Arthroscopic Anterior Cruciate Ligament Reconstruction

Author(s): Dr. Aminur Rasul, Prof Dr. Abu Zaffar Chowdhury, Associate Prof. Dr. Chowdhury Iqbal Mahmud, Dr. Debashish Dey, Dr. Md. Golam Shaikh Ferdous, Dr. Aynun Nahar Rabeya Diba, Dr. Md. Nazrul Islam

Background: The anterior cruciate ligament is a crucial stabilizer of the knee joint & its injury can lead to significant functional impairment, particularly in active individuals & professional athletes. The management of anterior cruciate ligament injuries, particularly the timing of surgical reconstruction, remains a debated topic in orthopedics and sports medicine.

Aim of the study: To compare the functional outcome between early versus delayed arthroscopic assisted anterior cruciate ligament reconstruction by quadruple strand hamstring autograft.

Methods: This prospective comparative study was conducted in the Department of Orthopaedic Surgery at Bangladesh Medical University from September 2022 to March 2025. A total of 44 patients were selected according to selection criteria and randomly assigned to two groups: Early (≤3 weeks) and Delayed (>3 weeks) groups depending on duration of injury & performed anterior cruciate ligament reconstruction by quadruple strand hamstring autograft. Assessments were performed both preoperatively and postoperatively at 1, 3, 6, and 9 months, using clinical and radiological evaluations. The functional outcomes were measured and compared using the Lysholm Score, Tegner Activity Score and range of knee motion. The analysis of various variables conducted following standard statistical methods with Statistical Package for Social Science version 26. Statistical significance determined at p-value <0.05 with a confidence interval at 95% were significant for all analyses.

Result: The study population had a mean age of 29.41±6.41 years, with 54.6% of participants were in 20-29 age range. Sports-related activities were the primary cause of injuries, accounting for 47.7% followed by road traffic accidents (RTAs) were at 38.6%. There were no significant differences between groups regarding demographic variables. Average graft diameter in early group was 7.4±0.5 & delayed group was 7.5±0.4. Post-surgery, 90% of the Early Group and 86.4% of the Delayed Group had negative anterior drawer test; respectively 86.4% and 81.8% had negative Lachman test. At final follow-up, Lysholm scores significantly improved to 90.14 ±3.82 (82 to 96) for the Early Group and 88.59 ±4.19 (80 to 94) for the Delayed Group (p=0.241). The Tegner activity score was 5.91 ±1.02 (5-8) in the Early Group and 5.86 ±0.71 (5-7) in the Delayed Group (p=0.841). In the Early Group, 63.6% achieved excellent outcomes, 31.8% rated as good, and 4.5% noted as fair. The Delayed Group displayed 50% with excellent outcomes, 40.9% were good, and 9.1% were marked as fair. Importantly, no participants in either group had experienced poor outcomes (p=0.624).

Conclusion: This study demonstrates that the functional outcomes of an anterior cruciate ligament reconstruction didn’t depend on the timing of the surgery, though a small difference in Lysholm score and Tegner activity and range of knee motion was in favor of early anterior cruciate ligament reconstruction over delayed reconstruction.